Ultrasound features of abdominal thrombosis in COVID 19 patients.

PURPOSE: Abdominal thromboses are a poorly characterized thrombotic complication of COVID-19. The aim of this paper is to report multimodality ultrasound imaging findings of the abdomen in evaluation of thrombotic lesions in hospitalized patients with COVID-19. PATIENTS & METHODS: In this retrospective observational study, patients admitted to a single University Hospital from April 1 2020 to April 30, 2022, who tested positive for COVID-19 and developed acute abdominal pain over the course of hospitalization were included. Abdominal ultrasound imaging studies performed in these patients were reviewed, including B mode ultrasound (BMUS), color-coded Doppler ultrasound (CCDS) and contrast enhanced ultrasound (CEUS). Thromboembolic findings on CT were also recorded. RESULTS: Finally, 13 cases of abdominal thrombosis in 226 Patients with COVID 19 infections were included (mean age, 56.69±8.97 years; 10 men, 3 women). Thromboembolic events including: iliac thrombosis (n = 4), portal venous (PV) thrombosis (n = 3), superior mesenteric vein (VMS) thrombosis (n = 2), inferior vena cava (IVC) thrombosis (n = 5) and inferior mesenteric vein (VMI) thrombosis (n = 1). In all cases of abdominal thrombosis, during high resolution BMUS scan, intra-luminary hypoechogenic appositional thrombi could be detected. Meanwhile blood flow with reduced speed less than 20 cm/s could be observed by CCDS. High arterial flow speed was a sign of collateral flow changes with diffuse venous dilatation. On CEUS, changes of the microcirculation of the liver, spleen, kidneys or small bowel by infarctions or micro-emboli could be detected. In 3 cases of PV thrombosis and in 2 cases of IVC thrombosis, catheter interventions were successful performed for recanalization without relevant lumen reduction afterwards. In other cases, without interventional procedure, partial recanalization happened with venous flow speed over 15 cm/s and lumen reduction more than 50% . CONCLUSIONS: Our study highlights those thromboembolic complications can be seen in hospitalized patients with COVID-19. Multimodality ultrasound examinations is helpful for early and accurate diagnosis of these complications.

Scoping Review: Ultrasonographic evidence of intraabdominal manifestations of COVID-19 infection.

COVID-19 is an infectious disease caused by the novel SARS-CoV-2 coronavirus that in the majority of patients will only cause mild symptoms. The most common serious complication is COVID-19 pneumonia, however, gastrointestinal (GI) COV-ID-19 is also a frequent presentation and likely due to the high expression of the ACE2 receptor in the GI tract. As diagnostic ultrasound has been frequently used in the management of this patient cohort, we conducted a literature search with the aim to present and review the currently published evidence of using ultrasound examinations in the management of intraabdominal manifestations of COVID-19. Our analysis showed that sonographic abnormalities of the hepatobiliary system are the most commonly reported findings in adults, while gastrointestinal abnormalities are the most common findings in children. The most severe complications are related to thromboembolic complications in the intensive care unit.

Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic.

BACKGROUND: Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES: Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS: US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS: Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS: Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.

Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic: Initial results of a pilot study1.

OBJECTIVE: The study aim was to investigate the use of a novel device, the Vscan Air™, for rapidly and effectively performing ultrasound in student teaching during the COVID-19 pandemic. MATERIAL AND METHODS: As part of the ultrasound practical course with integrated hands-on activity required by the regular medical curriculum, 100 medical students were instructed in the use of the Vscan Air™, including duplex mode. They then evaluated the quality of the ultrasound images obtained by the Vscan Air™ from previously selected organs. RESULTS: 100 students were interviewed (female n = 68, male n = 32; age >18 years n = 100). The rated image quality never fell below a mean of 3 for the examined organs and portal vein flow (liver 4,58; spleen 3,99; kidneys 4,29; aorta 4,16; Douglas/rectovesical space 4,14; portal vein 4,43; pancreas 3,53; Focused Assessment with Sonography for Trauma 4,38). Scores below 3 were found sporadically in ultrasounds of the spleen (n = 4), kidneys (n = 3), Douglas/rectovesical space (n = 2), and pancreas (n = 15). The liver was rated the lowest for 59 ratings. The portal vein was evaluated in 68 cases. The hepatic artery and hepatic veins could be also visualized in all 68 examinations. The aorta was evaluated in 62 cases. CONCLUSION: The Vscan Air™ technology offered adequate image quality and provided a new, fast and patient-oriented technique to support continuous ultrasound examinations and education of students, especially during a pandemic. Particularly noteworthy is the uncomplicated compliance with the required high level of hygiene.

The Use of Social Media for Medical Education Within Urology: a Journey Still in Progress.

PURPOSE OF REVIEW: This paper aims to discuss the growth of social media in urology over time, focusing on medical education platforms and best practices. RECENT FINDINGS: Social medial has facilitated physician and patient knowledge acquisition, conference participation, and mentorship. Several social media best practice statements are available, including from the American Urologic Association (AUA) and The European Association of Urology (EAU), to help ensure responsible use. The role of social media in urologic medical education has been amplified by the COVID-19 pandemic. Its utilization by urologists has been expanding, making it very valuable for physician and patient education. Future research should focus on ways to maximize these medical education efforts, minimize risks, and increase guideline awareness among users.

#UroStream101: Social Media as a Medium for Mentorship in Urology.

OBJECTIVE: Show feasibility of and develop a program to provide mentorship for applicants to urology residency during COVID-19 using a virtual program, #UroStream101. METHODS: Urology resident volunteers were paired with fourth year medical students based on shared areas of urologic interest and geographic location. A mentorship guide was provided. Mentees were offered an opportunity to design a twitter based educational resource, tweetorial, with mentor supervision. Program success was assessed by participation and with MEMeQ, a validated mentorship assessment survey. RESULTS: A total of 111 students and 93 urology residents enlisted in #Urostream101. All AUA sections were represented. At time of enrollment, 19% (n = 21) of medical students lacked affiliation with urology department, 24% (n = 27) lacked urology mentors, and 32% (n = 36) had no formal clinical exposure to urology. Many students joined twitter during the application cycle (45% within 1 month of enrollment, n = 50) for solely professional reasons (71% of participants, n = 79). When asked their top priority in participating in #UroStream101, most students answered resident mentorship (61%, n = 68) followed by exposure to a geographically distant urology program (32%, n = 36). Twenty tweetorials were created spanning the breadth of urology. A total of 29 students (26%) completed the full MEMeQ evaluation survey, assessing a student's goals and satisfaction with mentor. Overall program satisfaction was 6.1/7 on Likert scale, "very satisfied." Students identified program selection and ERAS application assistance as their main goals. CONCLUSION: #UroStream101 was a successful mentorship program for students interested in urology. This was desperately needed during an atypical application cycle and provides invaluable insight into further development of formal mentorship programs.

The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action.

The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic presents challenges to the real-time collection of population-scale data to inform near-term public health needs as well as future investigations. We established the COronavirus Pandemic Epidemiology (COPE) consortium to address this unprecedented crisis on behalf of the epidemiology research community. As a central component of this initiative, we have developed a COVID Symptom Study (previously known as the COVID Symptom Tracker) mobile application as a common data collection tool for epidemiologic cohort studies with active study participants. This mobile application collects information on risk factors, daily symptoms, and outcomes through a user-friendly interface that minimizes participant burden. Combined with our efforts within the general population, data collected from nearly 3 million participants in the United States and United Kingdom are being used to address critical needs in the emergency response, including identifying potential hot spots of disease and clinically actionable risk factors. The linkage of symptom data collected in the app with information and biospecimens already collected in epidemiology cohorts will position us to address key questions related to diet, lifestyle, environmental, and socioeconomic factors on susceptibility to COVID-19, clinical outcomes related to infection, and long-term physical, mental health, and financial sequalae. We call upon additional epidemiology cohorts to join this collective effort to strengthen our impact on the current health crisis and generate a new model for a collaborative and nimble research infrastructure that will lead to more rapid translation of our work for the betterment of public health.